Rules of Medicaid Eligibility

Medicaid Eligibility

The rules for Medicaid eligibility in Connecticut are very specific and precise. There is very little wiggle room for error. Here are some basics you should know about:

  • 5 year look back period

    The State of Connecticut’s Department of Social Services will look back at all your financial statements for all your accounts, whether active or closed, over the past five years from the month you are attempting to attain Medicaid eligibility.

  • $1,600 asset limit for an individual and your accounts must total $1,600 or less on last day of each month seeking eligibility

    A Medicaid benefits applicant may only have a maximum of $1600 in his or her name when applying for Medicaid benefits (this is called being “otherwise financially eligible”). It is important that the applicant’s accounts do not exceed this amount on the last day of each month while seeking eligibility and upon being granted benefits.

  • Real estate cannot be counted if making good faith effort to sell

    If you are single and will no longer be residing in your home, or if you are single or married and own additional properties, the state will ask that you put that property up for sale. The state’s position is that the sale proceeds should be used to pay privately for your care before the state will step in to do so.

    However, as long as you are making a good faith effort to sell the property during the Medicaid application process, then the state will consider the property an “inaccessible asset” and will not count it as an available asset during the application process.

  • Generally, your residence is exempt if:
    • The Medicaid applicant is expected to return home
    • Your spouse or a child under age 21 lives there
    • A disabled child, of any age, lives there
  • Assets held jointly are presumed to be owned solely by the applicant

    This means that if you have a bank account titled jointly with your son, the state will assume that your son’s name is on the account for convenience. Therefore, the state will consider the entire value of the account as owned solely by you. If your son contributed to the account, then you would need to show bank statements to that effect.

  • You are allowed an irrevocable burial contract up to $8000

    A Medicaid applicant is entitled to prepay her funeral as long as the funeral contract is structured and written in a particular way. The Medicaid applicant must have an irrevocable burial contract in an amount not greater than $8000. The contract must cover:

    • the use of a funeral home
    • the opening and closing of the grave
    • funeral home services

    Additionally, the funeral home can write a “burial space items contract” -- which may cover a casket, outer burial container, etc. – which can be of an unlimited value.

  • The cash surrender value of life insurance policies is excluded if the total face values of the policies do not exceed $1,500.
  • The total assets of the spouse at home must be evaluated on the Date of Institutionalization.

  • The date of institutionalization (DOI) is the date that the Medicaid applicant first needed the long term care. This could be the date the Medicaid applicant needed to enter a nursing home or the date that home care aides or family members began to actively take care of the Medicaid applicant at home.

    • The Community Spouse Protected Amount (CSPA): The Community Spouse may keep one half of the total assets up to a maximum of $119,220 or a minimum of $23,844

    • The Community Spouse is entitled to keep all of his/her income

    • The Community Spouse’s primary residence and one car are considered exempt assets and are not included as part of the CSPA

     Click here to learn How Transfers Affect Medicaid Eligibility

    Click here to learn about the Medicaid look-back period